Ann Thorac Surg 2006;82:2339-2340
© 2006 The Society of Thoracic Surgeons
Correspondence
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Sotarou Enatsu, MDa,c,
Junji Yoshida, MDa,
Mitsuyo Nishimura, MDa,
Yutaka Nishiwaki, MDa,
Kanji Nagai, MDa,
Tomoyuki Yokose, MDb,
Takayuki Shirakusa, MDc
a Department of Thoracic Oncology, National Cancer Center Hospital East
b Department of Pathology, National Cancer Center Research Institute East, 6-5-1, Kashiwanoha Kashiwa, Chiba, 277-85775 Japan
c Second Department of Surgery, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180 Japan
(Email: md040004{at}cis.fukuoka-u.ac.jp).
To the Editor:
We thank Dr Pramesh and colleagues [1] for their kind interest in our recent pleural lavage cytology (PLC) article [2].
At the National Cancer Center Hospital East, the 5-year survival rate of pathologic T4 patients, excluding stage IV, who underwent surgical resection during the same period as in the PLC article, was 32% as of October 2005. Log-rank test did not reveal a significant difference in survival between T4 and both positive pre-PLC (p = 0.92) and post-PLC patients (p = 0.09; Fig 1).
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Fig 1. Survival curves of positive pleural lavage cytology (PLC) and pathologic T4 (excluding M1) patients. There was no significant difference among the groups. Bold solid line = pT4 (n = 213); thin solid line = pre-PLC positive (n = 38); dotted line = post-PLC positive (n = 54).
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It is controversial whether intrapulmonary metastasis in the primary tumor lobe (pm1) should be classified as T4 [3, 4]. In our series, the log-rank test showed no significant difference between pm1 and other T4 patients (Fig 2;
p = 0.36). This may be partly because surgically resected T4 patients other than pm1 were very strictly selected cases and there was minimal tumor burden related to the T4 factor. Therefore these results need careful interpretation [1].
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Fig 2. Survival curves of patients with intrapulmonary metastasis in the primary tumor lobe (pm1) (dotted line) and other T4 patients (bold solid line). The 5-year survival rate was 33% for pm1 patients, which was not significantly different from other T4 patients (31%).
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References
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- Pramesh CS, Mistry RC, Agarwal J, Bishnoi R. Should pleural fluid cytology be incorporated in the TNM staging system for operable nonsmall cell lung cancer?(letter) Ann Thorac Surg 2006;82:2338-2339.[Free Full Text]
- Enatsu S, Yoshida J, Yokose T, et al. Pleural lavage cytology before and after lung resection in non-small cell lung cancer patients Ann Thorac Surg 2006;81:298-304.[Abstract/Free Full Text]
- Yano M, Arai T, Inagaki K, Morita T, Nomura T, Ito H. Intrapulmonary satellite nodule of lung cancer as a T factor Chest 1998;114:1305-1308.
- Okumura T, Asamura H, Suzuki K, Kondo H, Tsuchiya R. Intrapulmonary metastasis of non-small cell lung cancer: a prognostic assessment J Thorac Cardiovasc Surg 2001;122:24-28.[Abstract/Free Full Text]
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Should Pleural Fluid Cytology Be Incorporated in the TNM Staging System for Operable Nonsmall Cell Lung Cancer?
- C.S. Pramesh, Rajesh C. Mistry, Jaiprakash Agarwal, and Ramesh Bishnoi
Ann. Thorac. Surg. 2006 82: 2338-2339.
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